THE LIVED EXPERIENCES OF NURSES CARING FOR BURN VICTIMS AT A BURNS UNIT OF A ...

181 Pages·2015·2.06 MB·English

by  D Kamalizeni

THE LIVED EXPERIENCES OF NURSES CARING FOR BURN
VICTIMS AT A BURNS UNIT OF A PUBLIC SECTOR ACADEMIC
HOSPITAL IN JOHANNESBURG

Dorothy Kamalizeni

A research report submitted to the
Faculty of Health Sciences, University of Witwatersrand,
Johannesburg,
in partial fulfilment of the requirements for the degree
of
Master of Science in Nursing

Johannesburg, 2015.
ii

DECLARATION

I, Dorothy Kamalizeni, declare that this research report is my own work and is being
submitted for the degree of Master of Science in Nursing, at the University of
Witwatersrand in Johannesburg. It has not been submitted previously for any degree at
this or any other university.

Signature:

Date:

Protocol Number: M140463
iii

DEDICATION

I dedicate this work to the following:
 My parents, Mr and Mrs Malambo, for opening the gates to my education.
 The Stagecoach Bus Company of Scotland, under Ann Clog, for initiating and
supporting the establishment of the Burn Centre in Malawi in 1993, where my
passion for burn nursing originated.
 My late husband, Steven Nicholas Kamalizeni, for the good moments we shared
together.
iv

ACKNOWLEDGEMENTS

I thank God for the life I have and for taking me through my education path to this far.
I also thank the Malawi Government, National Aids Commission of Malawi (NAC) and
Kamuzu College of Nursing (KCN) for their interactions in the provision and facilitation of
the scholarship for this degree course through the Ministry of Health.
I further commend my lovely sons, Steven and Nicholas, for enduring my absence at
home when I was at school for this course. Special thanks go to my sister in marriage,
Rose Chisoni (the late Mrs Lovemore Kamalizeni), for taking care of my home and
children in my absence. God bless you for your time and love.
To my supervisor, Shelley Schmollgruber, I say ‘thank you’ for your guidance and
encouragement. I wholeheartedly appreciate your total commitment and mentorship in
getting this work accomplished.
I also extend my thanks to the following:
 Dr Sue Armstrong for taking us through the theoretical aspects of the research
process.
 Participants in this study for your time to share your experiences regarding caring
for patients with burn injuries.
 All burns unit staff for your support when I was in the unit collecting the data.
 My workmates at Queen Elizabeth Central Hospital for your support and
encouragement.
 My brothers and sisters for your support and prayers.
 All my friends for the continued encouragement.
God bless you all.
v

ABSTRACT

This study was intended to investigate the lived experiences of nurses caring for patients
with burn injuries. A qualitative, phenomenological descriptive design based on Husserl`s
(1962) philosophy, was used to achieve the study`s objectives. Registered nurse
participants (n=13) were recruited from the adult and children`s burns units of a public
sector academic hospital in Johannesburg. Data was collected using in-depth interviews
with the participants, which provided them with an opportunity to express their
experiences and opinions regarding caring for patients with burn injuries. The collected
data was analysed using a descriptive methodology utilising Colaizzi`s (1978) data
analysis approach.

There was a general expression amongst the participants that caring for patients with burn
injuries induced both physical and emotional discomfort, however good patient outcome
was a source of gratification. The source of stress included labour intensity, unsightly
nature of wounds and limitations in the provision for burns care with emphasis on
shortage of nursing staff and lack of organisational support.

There were apparently strong expressions that on-job training without recognisable
certification made the nurses and others doubt their capabilities in burns nursing practice.
The desire was for speciality training relating to burns care, with accompanying
recognisable certification.

Despite the prevailing challenges, the participants exhibited caring behaviour
characterised by commitment to duty, passion for the job and compassion for the patients,
which all enhanced professional boundaries and accountability. The findings of the study
further reflected that the participants acknowledged management and other sources of
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external support. However, there was evidence that participants engaged in establishing
their own mechanisms of coping with the prevailing challenges related to their job through
self-motivation, resilience, team work and team support. It was apparent the participants
demonstrated self-determination, perseverance and suppressed their stressful feelings to
continue with the nature of their work.

The findings of this study suggest that a supportive work environment coupled with
competency and empowerment among the nurses are critical for the wellbeing of the
patients and nursing staff in passing swiftly through the burns caring process. As the field
of burns care is just developing, especially in the Low and Middle Income Settings, a lot of
research is needed to determine the clinical, educational and management gaps in burns
care with focus on nursing perspectives. Replica studies can therefore be conducted in
other burns care settings to compliment the findings of the current study.
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TABLE OF CONTENTS

Page
DECLARATION ii
DEDICATION iii
ACKNOWLEDGEMENTS iv
ABSTRACT v
TABLE OF CONTENTS vii
LIST OF TABLES xiv
LIST OF FIGURES xv

CHAPTER ONE: OVERVIEW OF THE STUDY
1.0 INTRODUCTION 1
1.1 BACKGROUND TO THE STUDY 1
1.2 PROBLEM STATEMENT 3
1.3 PURPOSE OF THE STUDY 4
1.4 OBJECTIVES OF THE STUDY 4
1.5 SIGNIFICANCE OF THE STUDY 5
1.6 PARADIGMATIC PERSPECTIVE 5
1.6.1 Meta-theoretical Assumptions 6
1.6.2 Theoretical Assumptions 9
1.6.2.1 Terms of reference 10
1.6.3 Methodological Assumptions 12
viii

1.7 STUDY SETTING 13
1.8 OVERVIEW OF RESEARCH METHOD 13
1.8.1 Research Design 13
1.8.2 Research Method 13
1.9 TRUSTWORTHINESS OF THE STUDY 14
1.10 ETHICAL CONSIDERATIONS 15
1.11 PLAN OF RESEARCH ACTION 16
1.12 SUMMARY 16

CHAPTER TWO: LITERATURE REVIEW
2.1 INTRODUCTION 17
2.2 THEORETICAL FOUNDATION OF THE STUDY 19
2.2.1 History of the Environmental Theory of Nursing 19
2.2.2 Basic Concepts of Nightingale`s Theory of Nursing 20
2.2.3. Implications of Nightingale`s Theory to Nursing Practice 21
2.3 BURNS AS A TRAUMA EVENT OF PUBLIC CONCERN 21
2.3.1 Overview of Burns 21
2.3.2 Trauma and the Evolution of Burns Care 23
2.3.3 Current Approach to Burns Care 23
2.3.3.1 Burns care in High Income Countries (HICs) 24
2.3.3.2 Burns care in Low and Middle Income Countries (LMICs) 25
2.3.3.3 Burns care in South Africa 26
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2.4 NATURE OF BURNS AND THE BURN CARING PROCESS 27
2.4.1 The Nurse and the Burns Caring Process 30
2.4.2 The Nurse in the Burns Unit 33
2.4.3 Patients` Burn Pain 37
2.4.3.1 Overview of pain 37
2.4.3.2 The Nurses` experience with the patients` burns pain 38
2.5 STRESSORS AND COPING STRATEGIES IN BURN CARE 40
2.6 SUMMARY 46

CHAPTER THREE: RESEARCH DESIGN AND RESEARCH METHODS
3.1 INTRODUCTION 49
3.2 AIM AND OBJECTIVES 49
3.3 RESEARCH DESIGN 50
3.3.1 Qualitative research 50
3.3.2 Phenomenology 51
3.3.2.1 Overview of phenomenology 51
3.3.2.2 Approaches to phenomenological studies 51
3.3.2.3 Implications of phenomenology in nursing practice 54
3.3.3 Exploratory Study 54
3.4 RESEARCH METHOD 54
3.4.1 Research Setting 55
3.4.2 Target Population 55
3.4.3 Sample and Sampling Method 56
x

3.4.4 Data Collection 57
3.4.4.1 Pilot study 57
3.4.4.2 Data collection process 58
3.4.5 Data Analysis 59
3.4.5.1 The practical approach employed for data analysis in this study 61
3.5 TRUSTWORTHINESS OF THE STUDY 68
3.5.1 Credibility 69
3.5.2 Dependability 70
3.5.3 Confirmability 71
3.5.4 Transferability 71
3.6 ETHICAL CONSIDERATION 73
3.6.1 Permission to Conduct Research 73
3.6.2 Informed consent 73
3.6.3 Anonymity of Participants 74
3.6.4 Confidentiality 74
3.7 SUMMARY 75

CHAPTER FOUR: PRESENTATION OF THE STUDY`S FINDINGS
4.1 INTRODUCTION 76
4.2 PARTICIPANTS` DEMOGRAPHIC DATA 77
4.3 CLUSTERS OF THEMES 79
4.4 EMRGENT THEMES 80
4.4.1 Exhaustive Caring 80